Article
Treating patella instability in pediatric and adolescent patients: Systematic review of the literature
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Published: | October 23, 2013 |
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Objective: This systematic review aims at comprehensively and systematically reviewing the current evidence for orthopedic treatment of immature and adolescent patients with patella instability.
Methods: We searched the online databases PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) for relevant publications on patella instability. All dates and languages were included.
Results and conclusion: 20 papers reporting on a total of 456 knees in 425 patients (131 male, 294 female) patients followed for 56.7 ± 42.2 months on average, were included into the analysis. We found consistent, beneficial effects of surgical stabilization on clinical scores, postoperative stability and radiographic assessment in pediatric patients. There is no evidence for growth disturbance with surgical patella stabilization in immature patients. In conclusion, the current best evidence does not support the superiority of surgical intervention over conservative treatment in an acute patella dislocation. In recurrent patella instability in pediatric and adolescent patients, reconstruction of the MPFL is the most effective treatment option, can be done safely, and should be considered after a period of unsuccessful conservative treatment. For acute patella dislocations, conservative management remains the treatment of choice. For recurrent patella instability, this systematic review revealed a reassuring safety profile for MPFL reconstruction in immature patients, as well as excellent effectiveness for all surgical stabilization